2013 Maryland Code
INSURANCE
§ 15-901 - Definitions


MD Ins Code § 15-901 (2013) What's This?

§15-901.

(a) In this subtitle the following words have the meanings indicated.

(b) “Applicant” means:

(1) for an individual Medicare supplement policy or subscriber contract, the individual who seeks to contract for insurance benefits; or

(2) for a group Medicare supplement policy or subscriber contract, the proposed certificate holder.

(c) “Carrier” means an insurer, nonprofit health service plan, or fraternal benefit society that is authorized to issue health insurance policies under this article.

(d) “Certificate” means a certificate that is delivered or issued for delivery in the State under a group Medicare supplement policy.

(e) “Certificate form” means the form on which the certificate is delivered or issued for delivery in the State by the carrier.

(f) “CMS” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

(g) “Medicaid” means the Health Insurance for the Aged Act, Title XIX of the Social Security Amendments of 1965, as amended.

(h) “Medicare” means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as amended.

(i) “Medicare benefit period” means the unit of time used in the Medicare Program to measure use of services and availability of benefits under Medicare Part A.

(j) “Medicare eligible expense” means a health care expense of the kind covered by Medicare to the extent the service for which the expense was incurred is considered reasonable under Medicare rules and regulations.

(k) (1) “Medicare supplement policy” or “Medigap policy” means an individual or group policy of health insurance or subscriber contract that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of individuals eligible for Medicare.

(2) “Medicare supplement policy” or “Medigap policy” does not include:

(i) a policy that is issued pursuant to a contract under § 1876 of the federal Social Security Act, 42 U.S.C. § 1395mm; or

(ii) a policy that is issued under a demonstration project authorized pursuant to amendments to the federal Social Security Act.

(l) “Policy” includes:

(1) a policy that is issued to an individual;

(2) a certificate, as that term is used in Title 14, Subtitle 1 of this article, that is issued to an individual subscriber;

(3) a certificate, as that term is used in Title 8, Subtitle 4 of this article, that is issued to a member of a fraternal benefit society; and

(4) a group policy authorized to be issued under this article.

(m) “Policy form” means the form on which the policy is delivered or issued for delivery in the State by the carrier.

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